Chest pain, sinus tachycardia, and ST Elevation

I was reading through ECGs on the system when I saw this one:Sinus tachycardia, rate 120Computerized QTc = 380 msWhat do you think? I was immediately worried about a proximal LAD occlusion.  Although sinus tachycardia generally argues against ACS, a large anterior MI may result in such poor stroke volume that there is compensatory tachycardia and possibly impending cardiogenic shock. I looked to see if there was an ED cardiac ultrasound, and there was:Parasternal Long Axis:Poor image, but one can see that there is poor apical functionParasternal short axis:This shows poor contractility of the anterior wall.Contrast the shortening and thickening of the posterior wall (opposite the transducer) to the anterior wall (closest to the transducer)Apical 4 chamber:Apical wall motion abnormalityThe base is contracting well.At this point I still knew nothing about the patient, but was worried about an acute anterolateral STEMI (Proximal LAD occlusion).I went to talk with the treating clinicians.  They too were worried about LAD occlusion and had consulted cardiology.Here is the history:An elderly woman with history of diabetes and hypertension presented ambulatory with acute onset of crushing 10/10 chest pain that radiates to the back.  It started one hour prior to arrival.  She has never had anything like this before.With that history, I had no doubt about the diagnosis.Cardiology performed a formal echo.  Here is the result.  (She had previous n...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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